To Shift or Not to Shift, That is the Question
Written by Maria T. Bounos, RN, MPM, CPC-H | Monday, 17 November 2014 05:00
It’s that time of year again: now that all of the major 2015 Federal Register Final Rules are published, many of us find ourselves scurrying to assess how these payment systems, Inpatient, Outpatient, and Physician, just to name a few, are going to affect our business. Although the Inpatient Prospective Payment System for 2015 did not change much from a code-set perspective, the ICD-10 implementation date is right around the corner and will be here before we know it. It is imperative not to lose focus and assure that you are ready to not only answer the question of payment systems shifts but know the cause and how to remediate.
THIS IS IT. We are in our last year of preparation and organizations need to understand the financial shift from ICD-9 to ICD-10, how it impacts the bottom line, and what you need to do NOW to prepare prior to the implementation date. Understanding that from a reimbursement perspective, organizations have a lot going on right now, with a long list of to-dos that seems never-ending. It is our understanding that historically, providers struggle, as it is not always clear if they should start by analyzing the impact from a facility perspective, focus on the providers in their organization, or isolate specific service lines. In order for an organization to be successful, it will get the most mileage by analyzing patient claims data.
The impact of ICD-10 for organizations can be looked at from three different perspectives: True financial risk, potential financial risk, and low financial risk, and are defined as follows:
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